Athenahealth, Zus Health founder Jon Bush Q&A

One particular of the earliest figures in health care engineering is building a comeback.

In 1997, Jonathan Bush started a women’s well being and natal treatment clinic named Athena Women’s Health, but pivoted less than two decades later to develop apply management and medical doctor billing equipment as Athenahealth. Around the ensuing 20 yrs, Athenahealth grew to become a big service provider of electronic health-related records and medical billing technological innovation with extra than 100,000 suppliers utilizing the company’s applications by the time Bush resigned in 2018 amid a protracted takeover bid from Elliott Money Management, the hedge fund run by activist investor Paul Singer.

Right after a few many years out of the video game subsequent currently being “full-on canceled,” as he places it (at the time of his ousting from Athenahealth, studies circulated about his treatment method of female workforce and his ex-wife), Bush returned to the healthtech game late previous calendar year, founding Zus Wellness, which is concentrated on building a shared overall health info system developed to be utilised by the developing crop of electronic health providers. Previous calendar year, Zus elevated a $34 million Collection A spherical of funding led by Andreessen Horowitz to make out his vision. Bush spoke to Rapid Organization about the change getting location in healthcare that he’s hoping to capitalize on, how healthtech founders can succeed as VC funding contracts, and what he will make of Amazon’s acquisition of OneMedical.

What do you see as shifting in healthcare? How are digital companies complicated established health techniques and what is the possibility there?
[With] common vendors, their treatment is linked to their geography and their referral designs are linked to other people in their region. The hospital alone can only serve the men and women that can travel there. They are in a community battle for a deep, vertical monopoly.

With the pandemic and the continued evolution of the plan of shared program tools like Twilio or Stripe, there’s also been countless numbers of corporations that were being born and raised during the pandemic to use our new acceptance of digital-first [experiences] to do a large swath of care greater. Not by undertaking a vertical monopoly play, but as an alternative stating, “I’m likely to acquire a person narrow thing—anxiety, prediabetes—and crush it nationally.”

These new companies really don’t give a shit about vertical monopoly. They have no ideas on even owning an exam home, allow by itself a lab, a pharmacy, an operating space, an imaging heart. This new class of organization, blended with a new course of equipment and acceptance of digital-very first [healthcare] as high-quality, probably superior, developed a window—and that’s what acquired me back to perform.

What is Zus Wellness hunting to assistance these digital health and fitness businesses do?
Every PowerPoint slide in each individual meeting at every educational health-related center in the historical past of time due to the fact PowerPoint was invented asks, “Why really don’t we have a widespread health report, or at the very least why don’t we have interoperability?”

[Part of it is that] health-related information are made for the most important use circumstance of defending payment. It is not really what you would compose or request to see to optimally deal with somebody. You could scroll around and uncover some valuable shit and use your intuition to piece jointly the relaxation, but it’s genuinely designed as a data backing for acquiring a claim compensated, so there is a great deal of aggravation.

When a affected person comes somewhere, 90% of what comes about is about shit that’s by now took place someplace else—just tons of mapping that requires to be completed prior to any individual can supply you nearly anything, and all that shit is bloat. It is costly duplication.

The previous wellness companies really do not want to know about the other things, and they wouldn’t mind duplicating it due to the fact they probably have a pharmacy, imaging centre, or lab of their have. Those fellas want to [expand their scope and keep that patient pool], so they really don’t want to share facts with anyone else. They seriously never give a shit about what occurs much away from them.

[But now there is] this new class of firm that on their most egocentric working day are happy to share knowledge because that is not how they make dollars they can’t win by controlling your referral patterns further than what they are targeted on. They provide the significant thing you need to take up that worn out old PowerPoint slide, which is a business case. By getting really centered, they’d have a greater product or service if they could know what the hell else is going on [with a patient] without having getting to acquire it by themselves.

It turns out, they all require sort of the exact [tool kit]—you require a CRM stack, and it’s got to be HIPAA compliant, and it’s got to be safe, and you’ve bought to be equipped to connect documents. These companies have been expending the most expensive cash they’ll ever raise—that very first round—to establish it.

Zus suggests to these firms: You aren’t going to earn by currently being in a position to get the simple details on the patient—everyone requirements that—and you aren’t heading to acquire by remaining ready to do client marriage administration. I’ll get you all that shit low cost and good—all API-very first, so no a person will know it is Zus guiding the scenes.

The Zus dream is not currently being a star. It’s heading from currently being a waterboy to a potent water person. And which is exactly where that ends. We just want to be the enabler of a thousand good corporations, and if we can make that hot, a lot of, a lot of sexy points will come about upstream of us.

Between those more recent firms you’re conversing about that are constructing new products is One particular Medical, which is executing principal treatment in a diverse way. What do you make of Amazon obtaining One particular Medical?
As classic health care assumes an ever further vertical monopoly posture, that is ever extra at odds with shopper fascination, and as medication itself turns into evermore subspecialized, the have to have for a hyper clever (usually-on) layer that is not beholden to any 1 healthcare facility is finally coming into its very own.

The obtained old-faculty practices of most overall health systems do not have the technology or other details management sophistication important to be right away out there when inquiries and issues come up. However most of the early electronic wellness solutions lack personal knowledge of the patient. Amazon/Just one Professional medical spans both of those. The problem they will deal with is shopper alignment. When Amazon has been able to hold its genuine North Star at any time “closer to the customer,” 1 Medical has necessary to seek out payment from one particular hospital provider over another. This channel conflict with consumer fascination will be very tough to iron out as the industry heats up.

You are no stranger to healthtech, but now you have gone back again to becoming a founder at an interesting time—VC financial investment in digital wellness is slowing down. How have you approached setting up Zus in this natural environment and what suggestions do you have for other founders?
Start out with prevalent tools—don’t reinvent the wheel. Hire the wheels and then build a thing distinctive on top of it. When capital was abundant and there was no constraint, you could be as sloppy as you want and continue to appear fantastic as prolonged as you got shopper growth and some sort of medical benefits that professionals could agree have been true. Not true anymore.

You need to display very long-time period worth, and if you are blowing a whole lot of cash on shit that’s not one of a kind, you will not be ready to show that. Swiftly get to the point that no just one else has and spend all your R&D, design, product time on that and rent all the things else, at minimum till you get to break even or get to some sort of operational stability. That may possibly be noticeable assistance, but in the course of this last orgy of approximately cost-free money, people today forgot it, and quite a few younger people today commenced firms not at any time knowing that was a thing, and they are about to get a significant bucket of h2o on their head conveying it to them.

I’ve watched in a pretty small interval of time this digital well being space go from a globe in which folks really do not even know what VC is to persons who believe VC is a human appropriate. It in all probability will not go back to zero—”I’m sorry, son, but venture money is not definitely for healthcare”—but a little something like “venture money is not seriously for companies with no ideas to at any time make money.”

Funding is a single hurdle for new corporations, talent is yet another. How is getting prime expertise into healthtech distinctive now than when you ended up commencing out?
When I begun Athena, there was really this renaissance of people figuring out that the world wide web could do a lot more than university weblogs and choppy porn, and all of a unexpected, there were being all these opportunities, but nobody’s considering about health care. [We asked ourselves,] what would you have to do to trick brilliant young persons into basically taking their expertise and putting them in health care? A big portion of making Athena was that arbitrage—getting some amazing individuals that would not or else have been located in healthcare.

Just as we tried out to attract younger, vibrant men and women to health care tech in the late ’90s, 2000s, there’s now a entire bunch of individuals that are sort of existentially unsettled even though they operate at their [tech job]. It doesn’t truly feel superior generating the algo superior this month, but traditionally, if you move to healthcare, you’re heading to go backwards. We hope now that we can say: It is not gross what you’re doing work on, and the resources below are just as neat, the scale is just as grand.